The impact of antenatal HIV diagnosis on postpartum childbearing desires in northern Tanzania: a mixed methods study.
The impact of antenatal HIV diagnosis on postpartum childbearing desires in northern Tanzania: a mixed methods study.
复制标题
DOI：
10.1016/s0968-8080(12)39634-1
复制
发表时间：
2012-12-01
影响因子：
--
通讯作者：
Zaba, Basia
中科院分区：
文献类型：
--
作者：
Keogh, Sarah C;Urassa, Mark;Zaba, Basia
随着常规产前艾滋病毒检测的扩大，越来越多的妇女发现自己在怀孕期间艾滋病毒呈阳性。虽然有几项研究研究了艾滋病毒对非洲生育的影响，但很少有研究集中在产前/产后阶段。解决这一研究差距将有助于为艾滋病毒阳性妇女的需求量身定做避孕咨询。我们的研究衡量了产前诊断艾滋病毒如何影响产后生育意愿，并在诊断前对艾滋病毒的影响进行了调整。在5284名产前客户接受常规艾滋病毒检测之前，对他们的生殖行为进行了基线调查。15个月后，一项后续调查收集了2162名女性产后生殖行为的信息，并对25名女性进行了深入采访，调查了她们对艾滋病毒和生育的态度。HIV诊断与生育意愿的长期下调有关，但与产后短期欲望的变化无关。定性访谈确定健康问题和护士的劝阻是阻碍诊断后生育的主要因素。与此同时，亲歧视的社会规范似乎给女性施加了压力，要求她们继续生育。考虑到产前艾滋病毒诊断后生育意愿可能发生变化，应从产前到产后连续提供避孕咨询，同时考虑到艾滋病毒阳性妇女在生育方面面临的相互矛盾的压力。
With the expansion of routine antenatal HIV testing, women are increasingly discovering they are HIV-positive during pregnancy. While several studies have examined the impact of HIV on childbearing in Africa, few have focused on the antenatal/postpartum period. Addressing this research gap will help tailor contraceptive counseling to HIV-positive women's needs. Our study measures how antenatal HIV diagnosis affects postpartum childbearing desires, adjusting for effects of HIV before diagnosis. A baseline survey on reproductive behavior was administered to 5,284 antenatal clients before they underwent routine HIV testing. Fifteen months later, a follow-up survey collected information on postpartum reproductive behavior from 2,162 women, and in-depth interviews with 25 women investigated attitudes toward HIV and childbearing. HIV diagnosis was associated with a long-term downward adjustment in childbearing desires, but not with changes in short-term postpartum desires. The qualitative interviews identified health concerns and nurses' dissuasion as major factors discouraging childbearing post-diagnosis. At the same time, pronatalist social norms appeared to pressure women to continue childbearing. Given the potential for fertility desires to change following antenatal HIV diagnosis, contraceptive counseling should be provided on a continuum from antenatal through postpartum care, taking into account the conflicting pressures faced by HIV-positive women in relation to childbearing.